Study Compares Impacts of Draining Tunnels on Patients with HS

Individuals with moderate-to-severe hidradenitis suppurativa (HS) and draining tunnels experience greater clinical and health-related quality of life (HR-QoL) impacts compared to patients without draining tunnels, new findings suggest.1

These findings resulted from new research conducted to characterize the clinical profile of individuals diagnosed with moderate-to-severe HS, specifically looking at patients with and without draining tunnels.

The investigators—led by JR Ingram, MSc, of University Hospital of Wales—noted that previous research has outlined the high HS-associated burdens faced by patients. They added that prior data had also been published describing the suboptimal management of the skin disease and the high level of HR-QoL impacts on those with the disease.2

“However, the impact of draining tunnels on the burden of HS has not been explored in detail,” Ingram and colleagues wrote. “This study used real-world data to explore the clinical and HR-QoL burden in patients with moderate–severe HS with and without draining tunnels.”1

Impact of Draining Tunnels on HS-Related Quality of Life

The investigators set out to compare individuals with HS that either had or did not have draining tunnels, examining their clinical characteristics and assessing the burden of the disease on HR-QoL from the views of patients as well as clinicians. Using the Adelphi HS Disease Specific Programme (DSP), a cross-sectional survey in which data is gathered retrospectively, they conducted their analysis.

The analysis involved patients who had a confirmed HS diagnosis, were at least 10 years of age, and were not currently enrolled in clinical research. Eligible clinicians would have to be dermatologists with at least 2 HS patients that were managed within the year preceding data collection.

Draining tunnels were described in this study as linear tracts that could open onto the skin surface, allowing drainage either at rest or when they were compressed. The severity of patients’ disease was not pre-defined by the investigators but was instead determined by clinicians using their judgement.

The research team’s survey spanned 6 countries, including France, the US, Germany, Spain, Italy, and the UK. The study was done between November 2020 - April 2021. Throughout their analysis, the team assessed information from their clinician and patient surveys as well as patient record forms.

The clinicians involved in this study completed patient record forms for 5 - 7 consecutive patients being treated for HS. During their data collection, the research team looked at participants' history of treatments, demographics, disease characteristics, existence of draining tunnels, and overall clinical burden, with any missing responses or “don’t know” answers regarding draining tunnels being excluded from the analysis.

An invitation was later provided to participants to fill out a voluntary survey detailing their experiences with HS. The investigative team also incorporated validated HR-QoL tools into the survey to assess quality of life.

There were 580 individuals with moderate-to-severe HS, and the team concluded that 46% had draining tunnels. The investigators observed an increase in the prevalence of inflammatory nodules, abscesses, and scarring among individuals reporting draining tunnels.

Those with draining tunnels, compared to those without, reported significantly increased rates of drainage from lesions (62% versus 40%), redness or inflammation (73% versus 63%) and pain when seated (48% versus 37%) (P < .05). The study also demonstrated that biologic medications were more commonly prescribed to those with draining tunnels compared to those without (41% versus 27%, P < .05).

Despite this conclusion, the investigators noted that a notable proportion of eligible participants had not been given any biologics. The research team also found than significant psychological and systemic symptom increases were seen among those with draining tunnels, highlighting disturbances to patients’ sleep (28% versus 19%), lowered mood or reports of depression (30% versus 18%), and fatigue (28% versus 18%) (P < .05).

Overall, these data highlight the notably high level of impacts on clinical and quality-of-life linked to draining tunnels in those with HS. The team noted that such findings emphasized the necessity for effective disease management strategies.

“Future research characterizing the independent effect of draining tunnels on the well-being of patients with HS should objectively assess disease severity with inclusion of a draining tunnel count,” they concluded.1

References

1. Ingram JR, Marzano AV, Prens E, Schneider-Burrus S, Warren RB, Keal A, et al. Hidradenitis suppurativa with and without draining tunnels: A real-world study characterizing differences in treatment and disease burden. J Eur Acad Dermatol Venereol. 2025; 00: 1–11. https://doi.org/10.1111/jdv.20550.
2. Ingram JR, Bettoli V, Espy JI, Kokolakis G, Martorell A, Villani AP, et al. Unmet clinical needs and burden of disease in hidradenitis suppurativa: real-world experience from EU5 and US. J Eur Acad Dermatol Venereol. 2022; 36(9): 1597–1605.